Corneal Surgery FAQ

What is the cornea?

The cornea is the clear front of the eye that covers the colored iris and the round pupil. Light is focused while passing through the cornea so that we can see. To stay clear, the cornea must be healthy.

But something may have happened to your cornea. It is hazy or damaged because of disease or injury. If the cornea is damaged it may become swollen or scarred. In any case, its smoothness and clarity may be lost. The scars, swelling or resulting irregular shape cause the cornea to scatter or distort light, resulting in glare or blurred vision. Like a foggy window, light no longer passes through it well, so a blurred image forms in your eye.

Am I a candidate for a corneal transplant?

A corneal transplant is typically needed when:

Vision cannot be corrected satisfactorily using other medical approaches.

Painful swelling cannot be relieved by medications or special contact lenses.

Corneal failure occurs after other eye surgery, such as cataract surgery.

Severe Keratoconus, a steep curving of the cornea, develops.

Hereditary corneal failure, such as Fuchs’ dystrophy, exists.

Scarring after infections, especially after herpes, occurs.

Rejection occurs after first corneal transplant.

Scarring arises after injury.

What happens once my doctor and I agree I should have a corneal transplant?

Before surgery

Once you become a corneal transplant candidate, your name is put on a list at the local eye bank for donated cornea tissue (much like the case of an organ recipient). Typically, the wait is short due to the tremendous efforts of local and national eye bank organization awareness about cornea donations in this country.

Before a cornea is released for transplant, the eye bank tests the donor for the viruses that cause hepatitis and AIDS. The cornea is carefully checked for clarity. You may be required to have a physical examination and other special tests prior to surgery. If you usually take medications, ask if you should continue them up to the day of surgery. In certain situations, it is best to match the blood types of donor and recipient. If this is your situation, you will be asked to have a blood sample drawn when preparing for transplant surgery.

Day of surgery

Surgery is often done on an outpatient basis. You may be asked to skip breakfast, depending on the time of your surgery. Once you arrive for surgery, you will be given eye drops and medications to help you relax.

The operation is virtually painless. Anesthesia is either local or general, depending on your age, medical condition and eye disease. You will not see the surgery while it is happening, and will not have to worry about keeping your eye open or closed.

The surgery

The eyelid is gently opened. Looking through a surgical microscope, your eye is measured to tailor the corneal issue to be transplanted. The diseased or injured cornea is carefully removed from the eye. Any necessary additional work within the eye, such as removal of a cataract, can often be completed at the same time. Then the clear donor cornea tissue is sewn into place. When the operation is over, a shield is usually placed over your eye.

After surgery

If you are an outpatient, you may go home after a short stay in the recovery area. You should plan to have someone else drive you home. An examination at the doctor’s office will be scheduled for the following day.

Your post-operative instructions will ask you to:

Use the eye drops as prescribed;

Be careful not to rub or press on your eye;

Use over-the-counter pain medicine, if necessary;

Continue normal daily activities except exercise;

Refrain from driving until you have received doctor’s approval;

Ask your doctor when you can begin driving;

Wear eyeglasses or an eye shield.

When your stitches will be removed will depend upon the health of the eye and rate of healing. Usually, it will be several months, at least, before stitches are removed.

What complications can occur with a corneal transplant?

Because corneal transplants use donor tissue, the donor tissue is rejected 5% to 30% of the time. The rejected cornea clouds and vision deteriorates. Most rejections, if treated promptly, can be stopped with minimal injury. Warning signs of rejection are:

Persistent discomfort

Light sensitivity

Redness

Change in vision

Any of these symptoms should be reported immediately.

Other possible complications include;

Infection

Bleeding

Swelling or detachment of the retina

Glaucoma

All of these complications can be detected and treated by an experienced cornea surgeon. Therefore, it is important that your post-operative care be supervised carefully by your surgeon.

A corneal transplant can be repeated, usually with good results, but the overall rejection rates for repeated transplants are higher than for the first time around. Irregular curvature of the transplanted cornea (astigmatism) may slow the return of vision but can also be treated. Vision may continue to improve up to a year after surgery. Even if the surgery is successful, any other eye conditions, such as macular degeneration (aging of the retina), glaucoma or diabetic damage may limit vision after surgery. Even with such problems, corneal transplantation is still usually worthwhile.

A successful corneal transplant requires care and attention on the part of both patient and doctor. However, no other surgery has so much to offer in terms of vision improvement when the cornea is deeply scarred or swollen. The vast majority of people who undergo corneal transplants are extremely pleased with their improved vision. Of course, corneal transplant surgery would not be possible without the hundreds of thousands of generous donors and their families who have donated corneal tissue so that others may see.